CAJ | 학술논문

目的研究乳腺叶状肿瘤的基本的组织特征、病理诊断、鉴别诊断和分类标准,筛选各型肿瘤外科治疗的适宜术式,寻找临床和病理预后因素.方法对203例乳腺叶状瘤的病理形态学特征、临床因素和不同术式的疗效,按统计学软件SPSS(10.0)要求,建立数据库作Cluster、Focater、Logistic及Cox regression分析.结果203例叶状肿瘤可分为良性、交界和恶性三型,分别为133、42和28例;局部复发分别为28、19和18例;因瘤死亡分别为0、2和16例;在131例随访5年以上的病例中,5年生存率分别为100%、92%和33.3%.结论肿瘤性坏死具有重要的诊断价值.肿瘤性坏死、生长方式、异型性和核分裂数是在无错判条件下的肿瘤病理诊断参数集,亦是目前文献中最简化的诊断方案.良性、交界性和恶性叶状肿瘤应废止以往常用的肿物单纯切除术式;对于良性和交界性肿瘤至少应选择肿物连同周围2cm正常乳腺组织一并切除的扩大切除术;复发的交界性和恶性肿瘤要选择乳房单纯切除术式.叶状肿瘤的病理组织学等级(类型)与肿瘤的局部复发和因瘤死亡有统计学线性关系(P＜0.01);肿瘤的浸润性生长方式与肿瘤的复发有线性关系(P＜0.01);肿瘤性坏死和核分裂数值是独立的预后因素;术式等11个临床病理因素为单风险预后因素.
목적연구유선협상종류적기본적조직특정、병리진단、감별진단화분류표준,사선각형종류외과치료적괄의술식,심조림상화병리예후인소.방법대203례유선협상류적병리형태학특정、림상인소화불동술식적료효,안통계학연건SPSS(10.0)요구,건립수거고작Cluster、Focater、Logistic급Cox regression분석.결과203례협상종류가분위량성、교계화악성삼형,분별위133、42화28례;국부복발분별위28、19화18례;인류사망분별위0、2화16례;재131례수방5년이상적병례중,5년생존솔분별위100%、92%화33.3%.결론종류성배사구유중요적진단개치.종류성배사、생장방식、이형성화핵분렬수시재무착판조건하적종류병리진단삼수집,역시목전문헌중최간화적진단방안.량성、교계성화악성협상종류응폐지이왕상용적종물단순절제술식;대우량성화교계성종류지소응선택종물련동주위2cm정상유선조직일병절제적확대절제술;복발적교계성화악성종류요선택유방단순절제술식.협상종류적병리조직학등급(류형)여종류적국부복발화인류사망유통계학선성관계(P＜0.01);종류적침윤성생장방식여종류적복발유선성관계(P＜0.01);종류성배사화핵분렬수치시독립적예후인소;술식등11개림상병리인소위단풍험예후인소.
Objective To study the histopathological features, diagnosis criteria, the relationship of surgery pattern and prognosis of phyllode tumor of breast. Methods To analyze the histopathological features and clinical outcome of different surgery patterns in 203 patients with phyllode tumor of breast by Chi square test, Cluster, Focater, Logistic and Cox multivariate regression according to the request of SPSS 10. 0. Results 203 patients with phyllode tumor of breast were divided into three groups, i.e. benign 133 cases, borderline 42 cases and malignant 28 cases. Local recurrences in three groups were 28, 19 and 18, respectively. The patients died from tumor were 0, 2 and 16, and circulatory metastases were 0, 1 and 10, respectively. Five-year survival were 100 %,92. 0% and 33. 3% in the three groups of 131 patients by a 5 years' follow-up survey. Conclusions Tumor necrosis has important value in the diagnosis of phyllode tumor. Nature of tumor margin, cellular pleomorphism, frequency of mitoses and tumor necrosis were statistically appropriate composition in histological diagnosis of phyllode tumor. Wide local excision is preferred for the benign and borderline phyllode tumor, while simple mastectomy is indicated for recurred borderline and malignant, but tylectomy should be abolished in the treatment of phyllode tumor. Correlation of histotypes of phyllode tumor with local recurrence and tumor death was statistically significant at a level of P＜0. 001; correlation of infiltrative growth of the tumor with local recurrence was statistically significant at a level of P＜0. 001. Tumor necrosis and mitotic activity were independent prognostic factors.